Provider Demographics
NPI:1265510200
Name:WOODHULL HOSPITAL
Entity Type:Organization
Organization Name:WOODHULL HOSPITAL
Other - Org Name:PHS
Other - Org Type:Other Name
Authorized Official - Title/Position:ATTENDING
Authorized Official - Prefix:
Authorized Official - First Name:TADEUSZ
Authorized Official - Middle Name:
Authorized Official - Last Name:WITKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-630-3220
Mailing Address - Street 1:6421 BOOTH ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3028
Mailing Address - Country:US
Mailing Address - Phone:917-734-2198
Mailing Address - Fax:
Practice Address - Street 1:6421 BOOTH ST APT 4C
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3028
Practice Address - Country:US
Practice Address - Phone:917-734-2198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218442261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB10866Medicare UPIN